AlloDerm in Breast Reconstruction:2 Years Later

Abstract

Sir: Recently, we have seen a significant amount of attention directed toward the placement of acellular dermal grafts in breast reconstruction as first described by Dr. Parikh et al.1 In our practice, we were presented with a patient who had previously undergone bilateral breast reconstruction using this technique who had become disillusioned with her silicone implants and had requested autologous reconstruction. At operation for removal of bilateral implants and reconstruction by deep inferior epigastric perforator flaps, we encountered the acellular dermal graft material that had been placed 2 years previously. This presented us with a unique opportunity to examine the biological material currently being used commonly in breast reconstruction after it had been in situ for 24 months. Grossly, the material was easily discernible from the adjacent natural structures. However, it did appear that the material had incorporated into the surrounding architecture, requiring electrocautery to dissect it free. After complete removal, the material was sent to the surgical pathology laboratory, noting the history of breast cancer. Also requested were hematoxylin and eosin stains. After neoplasm had been ruled out, the pathologist had noted two important findings: (1) foreign body granulomatous reaction, presumably related to polypropylene suture (Fig. 1); and (2) significant deposition of collagen fibrils (Fig. 2). Both of these findings were noted to be “indistinguishable from the patient's own tissue.”Fig. 1.: Foreign body granulomatous reaction, presumably to polypropylene suture material, reported to be indistinguishable from the patient's own tissue (hematoxylin and eosin; original magnification, ×2000).Fig. 2.: Collagen fibrils in the graft material reported to be indistinguishable from the patient's own tissue (hematoxylin and eosin; original magnification, ×2000).Considering the increase in the use of acellular dermal grafts in breast reconstruction, we felt it important to communicate these findings to the community. It is likely that in the years to come we will gain more experience with the use of acellular dermal graft material in breast reconstruction and with the long-term results. DISCLOSURE None of the authors has received funding for this work or has any commercial association, financial interest, or disclosures to report in conjunction with this article. Martin I. Newman, M.D. Department of Plastic and Reconstructive Surgery Michel C. Samson, M.D. Department of Plastic and Reconstructive Surgery Mariana Berho, M.D. Department of Pathology Cleveland Clinic Florida Weston, Fla.